Education

Aletha Tippett MD's picture
Tetanus Immunization

by Aletha Tippett MD

Tetanus is a multisystem disease that occurs worldwide and is caused by the bacterium Clostridium tetani. This bacterium is present in feces and soil. Tetanus has been mostly eradicated in the United States because of childhood immunization; however, there have been reported cases among immigrants, as well as young adults who partake in higher-risk behaviors such as body piercing and tattooing and those who fail to maintain adult booster immunization. Other risk factors include diabetes or chronic wounds. It is fatal in approximately 10% to 30% of cases. Tetanus can be localized (with muscle contractions in the part of the body where the infection began) or generalized (affecting the entire body). Most reported tetanus cases are generalized.

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Temple University School of Podiatric Medicine's picture
Temple University

Diabetic foot ulcers do not always respond well to conventional wound healing methods for a multitude of reasons. Fibroblasts in people with diabetes have decreased migration and proliferation potential as a result of increased metalloproteinase levels in the wound bed of diabetic foot ulcers. These patients are also prone to bacterial infection within the wound because of the immunocompromised status of a patient with diabetes. Negative-pressure wound therapy (NPWT) can mediate these issues. The precise mechanism of action of NPWT is not clearly defined, but some possibilities have been conceptually determined. NPWT stimulates cell activity and migration, decreases bioburden in the wound by removing fluid, and reduces edema. However, the authors theorized that the increased pressure induced by NPWT on the skin could cause decreased tissue oxygenation in the wound bed.

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Janet Wolfson's picture
Lymphedema patients doing yoga

by Janet Wolfson PT, CLWT, CWS, CLT-LANA

For a long time, it was debated whether patients with lymphedema should partake in an exercise regimen. Today, fears of overloading the lymphatic system and of causing injuries have been resolved by research findings; however, there are precautions to take, and some types of exercise are more beneficial than others. When done correctly, these exercises can improve strength, quality of life, and ability to care for oneself and others, increase range of motion, decrease pain, and even reduce edema. Lymphedema-specific programs have been developed by wonderfully creative and knowledgeable people, too. As always, patients must consult with a health care provider before embarking on a new exercise regimen. If you are managing a patient who lacks strength or full range of motion, has difficulty in daily activities, or has problems walking, therapists can help develop a safe program and improve deficits to work up to a recreational exercise program.

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Margaret Heale's picture
Wound Research Data Review Including Outliers

by Margaret Heale RN, MSc, CWOCN

When looking at randomized controlled trials one of the first things you read is a one liner, "subjects were matched," and there may be a list that includes stage of pressure injury, size of wound, age, sex, and a myriad of other things somebody decided to include. There may also be exclusion criteria such as uncontrolled blood sugar, obesity, and being over 60 years old. It makes sense to do this, and there is no doubt that once you have got homogenous groups and compare the outcome of one with another, after whatever intervention you wish to discover the worth of, the result may look gratifyingly convincing.

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Janet Wolfson's picture
Lymphatic System

by Janet Wolfson PT, CLWT, CS, CLT-LANA

Manual lymphatic drainage (MLD) was developed by Emil and Estrid Vodder in the 1930s. They dedicated their lives to the study of lymphatic anatomy and physiology. Since then, others have modified the original techniques, including Foeldi, Leduc, Casley-Smith, and Bjork. They all involve manual contact with the client, deep diaphragmatic breathing, stimulation of the lymph nodes, and movement of fluid from proximal and then distal areas. The manual contacts are slow, gentle, and rhythmic. Practitioners are typically occupational or physical therapists, physical and occupational therapy assistants, nurses, massage therapists, and physicians. Many practitioners, after a required 135-hour training program, complete the Lymphedema Association of North America (LANA) certification exam.

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Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

Evolving negative pressure wound therapy (NPWT) technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications. In diabetic foot management, NPWT has had a significant impact on limb salvage. However, it is important to emphasize that diabetic foot management is a multidisciplinary effort, and NPWT is only one of the essential tools in overall management. Successful outcome is heavily dependent on all treatment modalities, including adequate wound debridement, appropriate antibiotic therapy, optimization of healing markers, and meticulous wound monitoring.

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Susan Cleveland's picture
Long-Term Care Patient

by Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

As a Director of Nursing (DON) in a long-term care facility, do you know where the awareness level of diabetes and its complications is for your staff? Do they realize diabetes doesn’t stop? It is 24/7, 365 days a year. Knowing this reality of diabetes and understanding the disease process may assist with preventing serious health problems such as heart disease, stroke, blindness, kidney disease, and nerve damage that can lead to amputation.

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Holly Hovan's picture
patient mobility and activity

By Holly Hovan MSN, APRN, CWOCN-AP

The Braden category of activity focuses on how much (or how little) the resident can move independently. A resident can score from 1 to 4 in this category, 1 being bedfast and 4 being no real limitations. It is important to keep in mind that residents who are chairfast or bedfast are almost always at risk for skin breakdown.

WoundSource Editors's picture
Diabetes and wound healing

For individuals with diabetes, all wounds are a serious health concern and require careful attention. Because of diabetic peripheral neuropathy, skin cuts and blisters often go unnoticed until they become more complicated to heal. In addition, internal wounds such as ingrown toenails, skin ulcers, or calluses can cause breakdown of tissue and an increased risk of infection. Even small cuts and insect bites can cause wound healing difficulties in patients with diabetes. Here are common factors of diabetes that impact wound healing:

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Fabiola Jimenez's picture
nursing career

By Fabiola Jimenez RN, ACNS-BC, CWOCN

Nursing has given me great opportunities; some of them I never imagined possible. I started as a medical surgical nurse in an oncology unit where the treatment of the day was gauze soaked in Dakin's solution for the management of post-op radical neck surgery. I moved on to intensive care, travel nursing, Army nursing, and endoscopy. It was in endoscopy and working with the colorectal surgeons, who helped me get my clinical experience while pursuing a master's degree in nursing, where I found out that it all could be tied together with a certification in wound, ostomy, and continence (WOC), and a wound care nurse is born!

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